21214 82ND PL WL FIRE PREVENTION
AWN
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SNOHOMISH C6. OEDMONDS
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FIRE Mountlak et pce 1) El BRIER
Phond, (425) 551-1200 0 MOUNTLAKE TERRACE
STR T www.FireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
" FREQUENCY STATION & SHIF__*'
LOCATION: 21214 82 tid PWca W 92026 Even 20-D
SCHEDULED
BUSINESS NAME: i3cn C:airi & &-sadiales PHONE: 425774.03024 DATE DUE II' Jun 2014
MAILINGI� UFIR � !�91 206
ADDRESS: 21214 S2nd Plafx)iV. Edamn&, %jVA W02E
BUSINESS OWNER: HOME PHONE:
42-S - '71
EMERGENCY-1: r-ain, Bun HOME PHONE: 1259:Z�l 3 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
EMAIL: BUSINESS o
LICENSE
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NAME OF INSP . ECTOR: o 2- ��"77
�-IHE SYS IEMS: FE lj_�
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
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4
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5
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6
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
E DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER.SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
7
'8
4
'8
DATE:
LE =ERNEEDED [:] YES No
I LETTERNEEDED [j YES [1 NO
1
8
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
LOCATION:
21214 82nd PI W
BUSINESS NAME:
Ben Cain & Associates
MAILING
21214 82nd PI W
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257748924
AL)L)hLZ)0: Edmonds 98026
BUSINESS OWNER: Cain, Ben HOME PHONE: 4253796113
EMERGENCY-1: Cain, Erin HOMEPHONE: 4256788548
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT-"*"
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SCHEDULED
DATE DUE 11- 06/01/10
UFIR ll� 591
6156
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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FIRE FE I
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HAZARDS FOZUND ND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 10
VIOLATION CODE
2
2
3
S4,
3
4
4
5
5
6
6
7
7
.8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONlAC7rED'.
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:____
DATE:
3
VIOLATIONS
1 5
_
MOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
8
LETTER NEEDED r
[_:] YES [C] N
[-L� TTER NEEDED 0 YES 0 NO
1
FIRE DEPARTMENT COPY